Comparing the risk of anaphylaxis requiring epinephrine in oral immunotherapy and subcutaneous immunotherapy: A review of recent Canadian real-world literature

Uliana Kovaltchouk, MD, FRCPC; Samira Jeimy, MD, PhD, FRCPC; Lianne Soller, PhD; Kara Robertson, MD, FRCPC; Elissa M. Abrams, MD, FRCPC; Scott B. Cameron, MD, PhD, FRCPC; Harold Kim, MD, FRCPC; Edmond S. Chan, MD, FRCPC

Journal of Allergy and Clinical Immunology: Global (May 2023)

Comparing the risk of anaphylaxis requiring epinephrine in oral immunotherapy and subcutaneous immunotherapy: A review of recent Canadian real-world literature

Uliana Kovaltchouk, MD, FRCPC,
Samira Jeimy, MD, PhD, FRCPC,
Lianne Soller, PhD,
Kara Robertson, MD, FRCPC,
Elissa M. Abrams, MD, FRCPC,
Scott B. Cameron, MD, PhD, FRCPC,
Harold Kim, MD, FRCPC,
Edmond S. Chan, MD, FRCPC

Affiliations

Uliana Kovaltchouk, MD, FRCPC: Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada; Corresponding author: Uliana Kovaltchouk, MD, FRCPC, Western University Clinical Immunology and Allergy, Western University, 1151 Richmond St, London, Ontario, Canada, N6A 3K7
Samira Jeimy, MD, PhD, FRCPC: Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada
Lianne Soller, PhD: Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
Kara Robertson, MD, FRCPC: Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada
Elissa M. Abrams, MD, FRCPC: Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
Scott B. Cameron, MD, PhD, FRCPC: Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
Harold Kim, MD, FRCPC: Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada; Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Edmond S. Chan, MD, FRCPC: Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, British Columbia, Canada

Journal volume & issue: Vol. 2, no. 2
p. 100080

Abstract

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Background: The safety of pediatric food oral immunotherapy (Ped-OIT) has been depicted by some as less favorable than subcutaneous immunotherapy (SCIT) owing to the increased number of serious adverse events requiring epinephrine. A review of real-world data comparing Ped-OIT and SCIT safety is necessary to guide shared decision making. Objectives: Our aim was to compare the safety and adverse event profiles of peanut Ped-OIT and SCIT using Canadian real-word literature. Methods: We performed a retrospective review of recent Canadian real-world literature on peanut Ped-OIT and SCIT safety and adverse events. Results: The incidences of systemic reactions requiring epinephrine were 11 in 270 patients (4.07%) and 12 in 41,020 doses (0.029%) in a multicenter study in British Columbia, Alberta, Manitoba, and Nova Scotia studying 270 preschool-age children treated with peanut OIT. Similarly, a multicenter study in South-Western Ontario examining 160 patients between the ages of 1 and 17 years who were treated with peanut OIT showed that the incidences of systemic reactions requiring epinephrine were 5 in 160 patients (3.1%) and 8 in 52,751 doses (0.015%). A single-center retrospective review of 380 patients receiving aeroallergen SCIT showed that the incidences of systemic reactions requiring epinephrine were 28 in 380 patients (7.4%) and 1 in 1047 injection visits (0.095%). These findings are comparable to those of a review of 860 patients in Ontario who received either aeroallergen or venom SCIT, in which the incidence of systemic reaction requiring epinephrine was 10 in 4242 injections (0.24%). Conclusion: Despite differences in the OIT protocols used and age groups studied, recent real-world data suggest that the safety of preschool peanut OIT or peanut OIT using a slower buildup schedule is comparable to that of SCIT.

Published in Journal of Allergy and Clinical Immunology: Global

ISSN: 2772-8293 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Immunologic diseases. Allergy
Website: https://www.sciencedirect.com/journal/journal-of-allergy-and-clinical-immunology-global

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